Tobacco Documents Online

and to learn new behavior patterns in order to stop smoking.19 The IBM "Plan for Life" also distributes the American Lung Association's booklets: "Freedom From Smoking" and "A Lifetime of Freedom From Smoking." Corporate Examples: Incentive Programs A handful of employers offer employees incentives not to smoke. Only 1.1~ or 9 of the companies which responded to the NICSH survey offer incentives. The companies that have tried the incentive approach have successfully reduced the percentage of smokers in the population. Most of the companies which sponsor incentive programs are small. One exception, Dow Chemical, is a major employer which reports great success. Dow Chemical Co. Dow Chemical Company discovered, in an internal study, that smokers were absent 5.1 days per year more than nonsmokers. This cost the company an estimated $500,000 each year. The response was the implementation of a variety of smoking cessation programs within the company. The Texas Operating Division launched a one-year lottery aimed at smokers. Smokers who quit earned one chance, for each month of abstinence, to win a motorboat val- ued at $2,400. In addition, abstinence earned workers a weekly bonus of $1 and a chance to win a $50 quarterly bonus. At the same time, a lottery for recruiters was established. Employees could recruit fellow workers to stop smoking. Each month the individual ref=ained from smoking, the recruiter won a chance for the motorboat. Of the Texas Division employees who smoked, 24'/. were recruited into the pro- gram. At the end of the year, 76% of the recruited employees did not smoke. Though the incentive program ended in 1975, Dow has continued to provide indi- vidual counseling during visits to the companyr2T edical department, periodic lectures, and presentations on smoking issues. Speedcall Corporation. Speedcall Cozporation offers its 35 employees $7 per week in extra pay if they choose to not smoke. The program is operated on an honor system and is voluntary. If an employee "backslides" and smokes one week, he is still eligible for the benefit in subsequent weeks. All employees are free to smoke during working hours; hence smokers are in no way penalized. The program operates on the philosophy that by rewarding nonsmokers with mone- tary incentives combined with peer pressure, smoking will be reduced.. The company reduced the percentage of the workforce that smoked by 70°~ and is saving an estimated $38 per employee in net resources. This figure excludes the financial transfers which the company treats as salary increases. On average, 74% of the employees receive an amount that averages $286 per year. Hence,the total cost of the program is $240 per employee. Other benefits in- clude: 97% of the employees thought the program was a good idea; cigar2~te consumption declined by 59%; and life expectancy increased by .8 years. 1-"A Plan for Life", the IBM Health Education Program, 1981. 20The National Interagency Council on Smoking and Health, op.cit. 21lnformation obtained during conversation with Dr. Fishbeck, Medical Director of Dow Chemical, Texas Division. 22Shepard, Donald S., Ph.D., "Non-Smoking Survey", the Speedcall Corporation, -138- T 40 TIMN 0086523

Gardner Hempel, the President, reported that absenteeism went down, there was less illness, illnesses were of shorter duration, and productivity went up following the implementation of the smoking program. In addition, the comp23y almost doubled its volume, with the same number of employees, in two years. Other companies that have offered incentive programs include:24 Cyberteck Computer Products,Inc. offered employees $500 to quit smoking. Vaughn Morgan, the President, estimated employees spend 3`/% of the workyear smoking. Using $22,500 as an average salary, he decided smoking cost his company $675 per year per smoker. City Federal Savings & Loan Association in Birmingham, Alabama has offered its 185 full-time employees $20 per month for not smoking. In 1977, $40,000 was paid to the 166 nonsmoking employees. Intermatic Inc. In 1976, President James Miller bet the employees up to $100, with the opportunity to double their money, to stop smoking for one year. Twenty-five winning employees received a total of $2,815 while 45 losers gave $1,105 to the American Cancer Society. Corporate Examples: Insurance Incentives Life, health and fire insurance rates are dramatically affected by smoking. Yet,few insurance companies offer incentives to individuals or employers to reduce this harmful habit. In discussions with the authors of this paper,sev- eral corporate•representatives indicated that their company would respond to financial incentives, such•as reduced premiums. For example, representatives from Bank of America indicated that a definite savings in the form of premium reductions could be the pivotal factor towards establishing smoking restrict- fons. Life Insurance. The statistically proven link between smoking and decreased life expectancy has led more than thirty life i2sburance firms to offer lower premiums on individual policies for nonsmokers. The Phoenix Mutual Life Insurance company offers a nonsmoker a discount on group life coverage for businesses with fewer than ten employees. Participa- ting employees must not have smoked for 12 months before enrolling in the plan. Phoenix Mutual reserves the right to verify the individual's smoking habits. 2~he discount ranges from 6% to 22%, depending on the employee's age and sex. August 1980. 23Fie1ding, Jonathan F.,'M.D., "Preventive Medicine and the Bottom Line", Journal of Occupational Medicine, Vol. 21, No. 2.1, February 1979. 24Kelliher, Eileen, V., op.cit. 25 Fielding, op.cit., Appendix A. 26 Business Insurance, June 15, 1981, p.19. -139- r ~ W3 TIMN 0086524

Fire Insurance. Though cigarettes are the cause of a substantial number of fires, few insurance companies are known to offer premium reductions for pla- ces of employment with smoking bans. Merle Normal Cosmetics was unsuccessful in negotiating a premium reduction following the implementation of their smo- king ban. .Conversely, Robin Woodward, owner of two restaurants in Seattle,negotiated21 25% premium reduction from Safeco Insurance company on her fire insurance. Health Insurance. Though the evidence that smoking causes illness is abun- dant, health insurance companies are reluctant to offer premium reductions for nonsmokers. Policy holders that are experience rated or self-insured realize premium reductions through lower utilization of medical services by nonsmo- kers. Purchasers of community-rated plans will not reap the benefits unless the entire community reduces their medical utilization. Therefore, the great- est need for direct premium incentives in health insurance'is for nonsmokers who need individual coverage or participate in community-rated plans. CORPORATE POLICIES THAT PROHIBIT OR RESTRICT SMOKING The NICSH survey reported that 49.6% of the responding companies had a smoking policy which restricted or prohibited smoking. The policy was instituted on a corporate-wide basis in 297. of the cases, while the others left this decision to each location. The policies restricted smoking in the following ways: Area No Restriction Restriction in. Designated Areas Complete Prohibition Dining 79.6% 18.5% 2.0% Blue Collar Areas 30.6% 42.07. 27.5% White Collar Areas 74.3% 15.2% 10.5% Conference Rooms 87.3% 6.2% 6.5% Medical Facilities 60.7% 14.7% 24.7% According to the survey report, restrictions are imposed primarily because of safety and health regulations. For example, smoking is prohibited in areas containing flammable goods, where food is prepared, or where workers come in contact with chemicals proven to have a hazardous, synergistic effect with smoking. This is one re29 on why more restrictions are imposed in blue collar than white collar areas. The Dartnell "Target Survey" reported that 23% of the 325 U.S. companies had a current policy covering smoking in the office in 1980. This was a 7% decline from a similar survey conducted in 1977. Elements of these policies include: 27Weis, op.cit., p.78. TIMN 0086525 28The National Interagency Council on Smoking and Health, op.cit. -140- T ~3 *26 5 £

- 18% restrict office smoking to certain designated areas - 87. have instituted special seating arrangements for smokers and non- smokers - 57% schedule breaks for smokers and nonsmokers29 The'Bennett and Levy survey found that 64% of the responding corporations (84) had designated work areas where smoking was prohibited. The two main reasons for establishing the policies were listed as: possible danger to products or equipment (91%), and direct contact with a client (17%). None of the respon- dents 1 18 ted the hazard to worker health as a reason for their nonsmoking policy. The current motivation for implementation of a no-smoking policy is to protect the quality of products or services rather than the health of the employees, according to these surveys. This finding is reinforced by the fact that most companies provide space where employees who work in a restricted area may smoke when they are on a break. The Bennet and Levy study reported that 80 percent of the companies with nonsmoking areas or nonsmoking jobs offered two or more smoking brea!ff daily for workers in these areas or jobs. The breaks averaged 15 minutes. Few companies extend the restrictions to employees who come in contact with neither the product nor the clients. The lack of restrictions on management staff is a prime example. Policy Considerations One of the barriers to implementing smoking regulations is that most companies are not adequately sensitized to the severity of the smoking menace and,thus, to the numerous reasons for prohibition of smoking. In addition, a body of experience is slowly developing that will influence future efforts to reduce the barriers to policy and program development. 1. The costs associated with smoking. Despite the overwhelming evidence of the otherwise unnecessary costs incurred by both employer and employee due to smoking, surveys show that few companies have used cost as the justifi- cation of a smoking program. One example of a company that recognized the costs of smoking and subsequently implemented a smoking ban was Merle Normal Cosmetics. The ban, which included all areas of the worksite ex- cept part of the cafeteria, was implemented in 1976. The company predic- ted they would save $36,000 during the first year of no smoking. Some of the costs included in this calculation were: the elimination of the cost of janitors emptying ashtrays and cleaning around them in all of the executive offices four times per day; reducing the need to clean and paint walls as the result of decreased smoke build.up; and•an estimated decrease in their fire insurance. 2"Target Survey, DartnelL's Business, June 1980, pp.37-40. 30Bennet and Levy, op.cit. - 31Ibid. TIMN 0086526 -141-

Merle Normal did not attempt to calculate the cost savings associated with health benefits or productivity. Absenteeism decreased during the first year of the ban. To ease the imposition of the ban, the company returned the expected savings during the first year of the program by giving each employee a $40 bonus. No complaints were received about the ban. In fact, several smokers wrote to the president thanking him for giving them the extra incentive they needed to kick the habit. Non52of the employees left the company because of the limitations on smoking. 2. Dangers of smoking to the health of the workforce. Though the dates of implementation of smoking policies (64% after 1964) suggest a relationship between the Surgeon General's Report on the health hazards of smoking and policy implementation, this is not substantiated by the Bennett and Levy survey or by interviews conducted by the author with representatives from major corporations. Employers seem to beZieve it is the employees' right to expose themselves to the risks linked to the smoking habit. 3. Smoking is an environmental hazard. The discovery that employees who work with certain substances have a much higher risk of an early death than their nonsmoking co-workers caught the attention of companies whose pro- ducts or production process included these substances. Increasingly, the argument is being made that any degradation of air quality poses a health hazard to all employees. Asbestos workers who smoke, for example, have a 92 times gJreater risk of developing lung cancer than nonsmokers with the same job. Johns Man- ville Co., the world's largest producer of asbestos, has been the most aggressive company to take action to reduce the number of smokers who work with asbestos. In the mid 70's, Johns Manville began implementing a five point approach to eliminate smoking in their plants. The plan provided: 1. Health information 2. Meetings between local management and union representatives 3. Presentations to the employees on the rationale for not smoking 4. Encouragement for workers to attend partially subsidized smoking cessation classes provided by SmokEnders 5. Institution of a smoking ban The company also decided to hire only nonsmokers.34 The company implemen- ted the program on the premise that there is sufficient epidemiological data to verify the adverse health effects that can result from the syner- gism between smoking and exposure to hazardous substances to warrant poli- cies that eliminate the interactions. 32lnformation obtained by the author from the public relations department of Merle Normal Cosmetics Co. 33The Smoking Digest, op.cit. TIMN 0086527 34Danaher, op.cit., from Johns Manville, Inc. (Health, Safety and Environment Department): Nonsmoking program; policies, program, history, implementation, education material. Denver, CO., 1978. -142- ~ ~~~~58

The company has stressed that smoking control is not a substitute for all other workplace environment changes; rather, it is an additional method of occupational environmental control. Paul Kotin, MD., Johns Manville's Senior Vice President for Health, Safety and Environment, believes the adverse effects of smoking must be addressed to completely comply with the Occupational Safety and Health Act of 1970 that states in Section 5(a): "Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that,are causing or 15e likely to cause death or serious physical harm to his employees." Local unions opposed the implementation of the smoking ban and policy to hire only nonsmokers. They did not dispute the evidence that smoking was hazardous in the work environment. They did, however, oppose the company's right to implement this ban and policy without going through the collec- tive bargaining process. The unions also opposed the bans because they were afraid the company would use the aggiessive smoking campaign to dodge compliance of the safety standards. They were concerned that this ban against a personal behavior would set a precedent allowing employers to ban other personal habits or set other health behavior related criteria for employee selection. Unions were also concerned about employees who have woNd at the company for many years who might not be able to stop smoking. Four grievances against the policy were filed in different states. Three of the four were decided in favor of Johns Manville and the bans are now in effect. The fourth was decided in favor of the union. In that case, the judge decided the company must go through the collective bargaining process to implement the ban. However, it was decided that the company can unilaterally implement smoking restrictions. This decision was upheld in an appeal to the Federal Court. Therefore, in the Texas plant of Johns Manville where the court derJPion occurred, a smoking restriction rather than a ban is now in place. 4. Secondary or passive smoking and nonsmokers rights. The recent studies on the health effects of involuntary smoking or breathing air contaminated with exhaled smoke have put increased pressure on employers to establish smoking restrictions or bans. Though the exact physical effect of invol- untary inhalation of tobacco smoke is being debated, two studies have sug- gested the health hazards are increased. 35Kotin, Pual, M.D., Lois Anne Gual, "Smoking in the Workplace: A Hazard Ignorded", American Journal of Public Health, June 1, 1980, Vol. 70, No. 6. 36lnformation obtained in a conversation with Dr. Paul Kotin, Sr. Vice Presi- dent for Health, Safety and Environment, Johns Manville Corporation, Denver, CO., July 1981. 37lbid. TIMN 0086528 ~, ~c- 59 -143- ' ~ i ~

a) A study correlated the deaths of 91,000 nonsmoking Japanese women with the smoking habits of their husbands. An increased chance of dying of lung cancer was repo5ged to be directly proportional to the amount of smoking in the home. b) Another study measured the long term effects of voluntary and involun- tary smoking on 2,100 middle aged people. It was determined that the nonsmokers and light smokers who did not inhale scored similarly on a spirometric test, a measurement of lung capacity. The above groups, that worked with heavy smokers, scored significantly worse than non- smokers working in smoke free environments. The conclusion drawn from the study was that chronic exposure to tobacco smoke in the work e34i- ronment significantly reduces small airways function in the lungs. Along with the potential increased risk of lung cancer and reduced lung capacity, many indiv48uals find cigarette smoking to.be an irritation to their eyes and skin. Problems associated with the health hazards and annoyance of exposure to smoky environments for employers are: .I11 employees are more expensive employees due to increased medical expenses, decreased productivity and increased absenteeism. .The effects on morale have been mentioned by many corporate represen- tatives. The resentment and friction between smokers and nonsmokers has been a problem. Nonsmoking employees have become more vocal, through comments in company newspapers, about their right to a smoke- free environment. 307. of the managers who responded to the Dartnell Survey r4?orted employees had raised the smoking issue at one time or another. .Law suits attempting to establish the rights of nonsmokers to a smoke- free work environment have been on the rise. In December 1976, the New Jersey State Superior Court decision in the Shimp vs. New Jersey Bell Telephone Company case established a precedent on nonsmokers' rights. In this instance, Donna Shimp developed a severe allergy to tobacco smoke and brought a suit against her employer, New Jersey Bell Tele- phone Company, to have smoking banned in her office. The company had already placed smoking restrictions in areas housing sensitive tele- phone equipment that could be damaged by cigarette smoke. The court ruled that the company must provide "safe working conditions" by re- stricting employee smoking to the lunch room and lounge on the reason- ing that "Human beings are also very sensitive and can be damaged by cigarette smoke. Unlike a piece of machinery, the damage to a human is 38Newsweek, Jan. 26, 1981. 39White, James R., Ph.D., Herman F. Froeb, M.D., "Small Airway Dysfunction in Nonsmokers Chronically Exposed to Tobacco Smoke", The New England Journal of Medicine, No. 13, Vol. 302, p. 720, March 27, 1980. 40Stewart, Susan, The Washington Post, June 27, Thirty-four million Americans are reported to be allergic or sensitive to cigarette smoke. 41„Target Survey", op.cit. TIlVIN 0086529 -144- 1'O3. ~r~60

all too often irreparable. A company which has demonstrated such con- cern for its mechanical components should have at least as much concern for its human beings. Plaintiff asks nothing mo42 than to be able to breathe the air in its clear and natural state." RECOMMENDATIONS The conference is designed to cause a reduction in smoking in the U.S. The various Work Groups represent sectors of society that are "targets of oppor- tunity." Each is to contribute to the whole by developing action plans that will help reduce barriers now impeding the.overall goal of a more smoke-free --and thus more healthy--environment. Following are a series of recommendations offered to stimulate Work Group dis- cussions. As written, they represent a range of concepts and approaches rather than a unified strategy. The recommendations are organized around the barriers identified earlier, although many are equally applicable to more than one. Finally, other recommendations are organized around more general topics such as dissemination and legislation. Barrier: Cost 1. Prepare a statement, publicly•endorsed by the participating organizations. and individuals, that contains proof of the cost savings companies can re- ceive from smoking policies-and programs. These should emphasize the point that current programs cost between $5-$400 while the savings per em- ployee per year range from $624-$4,611, based on the studies in the paper. 2. Develop a model cost-benefit equation that will assist companies in mea- suring their own success/failure. 3. Establish the basic elements of cost upon which all can agree. ' 4. From all the cost and economic information, select the points that will most effectively humanize the issue for individuals (a companion document to #1 above.) Barrier: Ignorance 1. Prepare a brief, hard-fact statement, endorsed by all, that supports smo- king policies and programs. The endorsement and the clarity of the state- ment are what should set this statement apart from those that already exist. a. With an appropriate coordinating mechanism, establish a high-visibility media campaign for the dissemination of the statement. This should be accompanied by supportive campaigns through existing channels such as the American Occupational Medical Association, U.S. Chamber, the Busi- ness Roundtable Task Force on Health, WBGH, unions, etc. Further, there should be a direct contact campaign where the CEO's of companies with programs agree to contact others who do not. This contact can range from direct exhortation to a single notification about the new joint statement and its importance. 42 The Smoking Digest, op.cit. From Shimp vs. N.J. Bell Telephone Co. Super- ior Court of NJ, Chancery Division, Salem County. Opinion of J.S.J. Cruccio, Docket No. C-2904-75, decided Dec. 20, 1975. -145- TIMN TIMN 0086530

NOTE: It will not be easy to get industry organizations to endorse any meaningful statement due to their fear of retaliation from the tobacco industry. 2. Develop a"model" corporate policy that encompasses: -optional policy statements -assistance for smoking cessation -option for incentives -typical community resources -communication systems that have worked elsewhere -vending medicine policy -smoke breaks -restricted areas 3. Select the key data that every corporate manager should know and which will favorably influence the decision to adopt smoking policies or pro- grams. For example, the ratio of absenteeism that stimulated the Dow program. In some cases, national averages or other corporate examples should be adequate. However, for other kinds of data it will be necessary to do the analysis on a company or even location-specific basis. For these cases, the provision of "how to" instructions will help overcome the ignorance barrier. Barrier: Resources 1. Through the Int.eragency Council or some other source, develop a directory of organizations that provide..smoking cessation programs. The components of the directory should include: a. program description, b. cost c. success rates with specific references d. duration e. space or other requirements f. ability to train in-house so the company can do its own programs g. names and credentials of key personnel h. geographic coverage i. affiliations j. tax status An employer-union committee should design the directory. The Interagency Council or perhaps HHS or AOMA should verify the information. Proprietary firms should be included. 2. Establish a program selection guideline chart to assist employers and un- ions who are in resource-rich areas. Barrier: Labor-Management Relations Establish a national level joint task force on smoking control. This group' would be responsible for: -146- TIMN 0086531 T33`%, ~6 2

1. Issuing a broad statement urging all employers, with union participation, to establish smoking policies and to provide smoking programs. The state- ment would include the rationale for smoking reduction,but would not dic- tate the specific policies to be articulated at the local level. 2. Develop an employment strategy for tobacco-related jobs that, hopefully, will become obsolete. The argument is often made that we cannot afford to really ban smoking due to employment. This is not so since the industry is a far greater drain on the economy than it is a contributor. However, we do need to have a realistic and compassionate plan for workers and small farmers who may be displaced. Barrier: Effectiveness The recommendations on the cost and ignorance barriers are also applicable to the effectiveness barrier. In addition, a guide needs to be created that ac- curately and objectively assesses the quality of existing programs and estab- lishes minimum performance standards, for specific populations, against which future programs can be measured. Further, the effectiveness of alternative policies need more work than do spe- cific programs on which a rather large body of data already exists. Any work on effectiveness must be sufficiently flexible to incorporate the many varied motives, measures and audiences that are involved. Barrier: Liability 1. A joint labor-management task force should work with OSHA to establish a consensus definition of worker safety that protects employers and unions that establish health-based restrictions. 2. Terms such as "smoke free" may not in fact be an adequate description of the air quality that is necessary for good health. Also, this may change over time as new technology produces improved "smoke-eaters" and air cir- culation systems. Currently there is no way to have such considerations help ameliorate the litigious atmosphere surrounding smoker vs. nonsmoker rights. 3. Work should be started with the American Arbitration Association to devel- op model arbitration and mediation systems for workers vs. worker and worker vs. management smoking disputes. General Recommendations 1. Develop a dissemination plan for the conference statement(s), recommenda- tions, and products. This should be of multiple-year duration, national in scope, and comprehensive in its attempt to reach the desired audience from different,but supportive sources (media, schools, church, medical, employment, etc.) The dissemination plan for corporations should not rely on CEO's only. Also to be included are: TIMN 0086532 -147-